Resident :Dr.

Melly Miranda
Supervisor:
Dr. dr. Amira Permatasari Tarigan, Sp.P (K)
 Bronchial Thermoplasty
(BT)

An alternative theurapeutic option for severe asthma

patients with persistent symptoms requiring step 5 of
controller treatment.
(GINA )

It has been proven to reduces symptoms in severe asthma , but the

mechanisms by which this is achieved are uncertain as most studies have
shown in improvement in spirometry.
 PERFORMED DURING BRONCHOSCOPY

RF thermal to airway (size 2-10mm)

With the intention of inducing athropy in hypertrophied airway
smooth muscle

A number of methods exist to evaluate physiological changes in the

small airways
These include:
1. Pletysmography
2. Impulse oscillometry
3. Inert gas washout
4. Sophisticated imaging techniques such as hypolarized magnetic
resonance imaging.
 This study aimed to evaluate
changes in measures of gas trapping
by body plethysmography.
 A Prospective Cohort

32 consecutive patients
With severe asthma who were listed for BT at two
Australian university hospitals were evaluated at three
time points :
1. Baseline
2. 6 weeks
3. 6 months after all procedures

At each evaluation
Medication usage, symptom scores (Asthma Control Questionnaire,ACQ-5)
and exacerbation history were obtained
• Lung function was evaluated by SPIROMETRY
• Gas diffusion (KCO) & Static lung volumes by body
PLETHYSMOGRAPHY.
• ACQ-5 improved from 3.0±0.8 at baseline to 1.5±0.9 at 6 months (mean±SD,
p<0.001, paired t-test).
• Daily salbutamol usage improved from 8.3±5.6 to 3.5±4.3 puffs per day
(p<0.001).
• Oral corticosteroid requiring exacerbations reduced from 2.5±2.0 in the 6
months prior to BT, to 0.6±1.3 in the 6 months after BT (p<0. 001).
• The mean baseline FEV1 was 57.8±18.9%predicted, but no changes in any
spirometric parameter were observed after BT.
• KCO was also unaltered by BT.
• A significant reduction in gas trapping was observed with Residual Volume
(RV) falling from 146±37% predicted at baseline to 136±29%predicted 6
months after BT (p<0.005).
• Significant improvements in TLC and FRC were also observed. These changes
were evident at the 6 week time period and maintained at 6 months.
• The change in RV was inversely correlated with the baseline FEV1 (r=0.572,
p=0.001), and in patients with a baseline FEV1 of <60%predicted, the RV/TLC
ratio fell by 6.5±8.9%.
 Bronchial thermoplasty improves gas trapping
and this effect is greatest in the most severely
obstructed patients. The improvement may
relate to changes in the mechanical properties
of small airways that are not measured with
spirometry. .